Ketamine is thought to work by modulating the glutamate system in the brain, specifically N-methyl-D-aspartate (NMDA) receptors. It leads to increased production of brain-derived neurotrophic factor (BDNF), which promotes increased connectivity within brain networks and promotes neuroplasticity. These neurochemical effects along with ketamine's rapid action sets it apart from traditional psychiatric medications.

Ketamine is FDA approved for use as a general anesthetic agent. However, ketamine in a lower, subanesthetic dose to treat depression, anxiety and post traumatic stress disorder (PTSD) is a newer, “off-label” use of ketamine (i.e. not FDA approved for the treatment of these conditions). Off-label prescribing is relatively common with one study showing about 33% of antidepressant prescriptions being furnished in an off-label manner within primary care settings.

While ketamine can provide rapid relief from mood symptoms short-term, the long-term and lasting benefits are best achieved when paired with psychotherapy done consistently and in earnest, as ketamine can promote relief from negative thought loops/obsessive thinking/depressed mood, increase openness, promote communication, provide access to difficult thoughts with less fear/anxiety and integrate a sense of newness and healing, all of which can facilitate psychotherapy in a more meaningful manner. Our goal is to set our patients up for the best possible chances of success, therefore patients are required to have a psychotherapy provider with whom they visit regularly.

We do not require you to visit with a specific psychotherapist. The most important aspects of therapy in relation to ketamine treatment are that you work with someone regularly and in earnest and that you feel safe/comfortable discussing sensitive issues with this individual. It can take time to find the right therapist, so it is important to come into the program with a therapist with whom you already have a working relationship.

This is very difficult to describe by most who have experienced the non-ordinary state of consciousness produced by ketamine. However, it is most commonly associated with a feeling of timelessness, dissolution of ego/self, profound revelation/emotion/experience, a sense of “higher reality,” feeling out of body/seeing oneself from outside their body, and alteration in sensations. A typical ketamine experience will last 45-75 minutes in duration.

There is a lot of media attention regarding psychedelics for mental health that portray ketamine and other psychedelic compounds as “miracle drugs” that achieve results with only a handful of dosing sessions. However, while ketamine will help people achieve rapid relief of symptoms in the short term with the first several sessions, lasting and sustained benefit requires a more prolonged course of treatment. That is to say, the brain and behavioral patterns do not change overnight. Generally, we at Slopeside Vitality break our treatment program into phases. The first phase is the dose-finding phase where we are determining what specific dose achieves satisfactory improvement in symptoms. The second phase involves holding the target dose for a minimum of 6-8 weeks while patients work with their therapist on at least a weekly basis. This second phase is where we are leveraging the neuroplasticity effects of ketamine; The lasting and sustained benefits are achieved by keeping symptom improvement at a satisfactory level all while allowing the brain networks involved in this positive mood change to become the default way of thinking. The third phase is where we gradually wean from the ketamine while monitoring for any decline in mood. A decline in mood during the third phase may require going back to the second phase and intensifying the frequency of therapy. Ketamine is not meant to be a long-term or maintenance medication, and we at Slopeside Vitality do not prescribe ketamine in this manner.

Studies have shown that ketamine can alleviate symptoms (at least 50% reduction in symptoms) in upwards of 70% of patients treated with ketamine. A small subset of patients may not respond to treatment and results are not guaranteed.

People with untreated/uncontrolled hypertension, untreated hyperthyroidism, schizophrenia/psychosis, bipolar disorder with active mania/hypomania, elevated intracranial pressure or untreated/uncontrolled glaucoma are not eligible for treatment. A history of stroke, heart attack or other cardiovascular disease may make a person ineligible for treatment. Dr. Sebesto will review your medical history in detail and determine if you have a medical condition that would exclude you from treatment. A medical clearance letter from your primary care provider or another specialist may be needed for medical clearance to initiate treatment in certain circumstances.

There is no evidence/study that suggests ketamine is addictive when taken as directed in a medically supervised manner. In fact, ketamine is now being explored for treating addiction and substance use disorders.

The most common side effects associated with ketamine administration include nausea, blurred vision, difficulty with balance and depth perception, sedation, fatigue and cognitive inefficiency. These side effects, if present, generally subside in the hours following a treatment session. A full list of potential side effects will be discussed during a consultation.

A 2022 study by researchers from NYU, UCSF, Cleveland Clinic and Houston Methodist involving 1247 patients taking at-home ketamine for anxiety and/or depression not only demonstrated the clinical benefit of at-home ketamine, but found at-home ketamine to be quite safe with only 4 participants (0.3% of participants) leaving the study due to non-life-threatening side effects. No study participants experienced any life-threatening side effects.

Patients can be prescribed ketamine in lozenge, rapid dissolving tablet, nasal spray or suppository forms.

Dr. Sebesto does not manage other medications including conventional psychiatric medications. However, he is available to coordinate care with your other prescribers.

We do not take insurance as at-home ketamine is not covered for the purposes of treating depression, anxiety and PTSD.